G9808 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9808: No Asthma Controller Medications Dispensed

HCPCS Level II code G9808 denotes patients who had no asthma controller medications dispensed during the measurement year. The code is used as a population-level indicator of gaps in long-term asthma controller therapy and informs quality measurement, population health management, and medication adherence monitoring. Nationally, this measure matters because inhaled corticosteroids and other controller agents are central to preventing exacerbations and reducing avoidable health care utilization.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, how it is applied in outpatient pharmacy and ambulatory settings, and the types of benchmarks and policy considerations typically associated with non-dispensing measures. The publication summarizes common modifiers and implementation considerations and highlights where data is available or absent.

The reader will learn practical context about service lines and sites of service relevant to G9808, understand payer coverage scope addressed in the review, and identify areas where additional clinical detail or coding crosswalks may be needed. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9808HCPCS Level IIasthmacontroller medicationsmedication adherenceoutpatient pharmacyambulatory carequality measure

Billing Code Overview

HCPCS Level II code G9808 identifies patients who had no asthma controller medications dispensed during the measurement year. This measure captures medication dispensing patterns related to asthma management and is used to flag patients without controller therapy over a 12-month measurement period.

Service type: Medication dispensation/medication adherence measurement
Typical site of service: Outpatient pharmacy and ambulatory care settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 12-year-old patient with a history of persistent asthma presents for an annual quality measure review. The clinic's population health team runs a pharmacy reconciliation and finds G9808 applies because the patient had no asthma controller medications dispensed during the measurement year. The typical workflow: the outpatient pediatrician or primary care clinician reviews the patient chart during a scheduled visit or outreach call, confirms asthma diagnosis and severity, documents current symptoms, recent exacerbations, and any medication intolerance or nonadherence. Pharmacy fill histories and state immunization/PDMP/pharmacy portals are checked. The clinician documents reasons for absence of controller therapy (e.g., mild intermittent disease, medication refusal, access barriers, resolution of symptoms, or documented contraindication). Coding/billing staff capture G9808 on the encounter to indicate the patient had no controller medication dispensed in the measurement year for quality reporting. Typical site of service is outpatient primary care or pediatric clinic; services often occur during preventive or chronic care visits and via care management/telehealth outreach.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when substantially greater work is performed during an encounter documenting extensive counseling or coordination related to asthma management beyond usual visit content.

HCPCS G0155: Clinical Social Worker Services in Home Health or Hospice

HCPCS-G8776-SERUM-CREATININE-NOT-PERFORMED

HCPCS G8776: Serum Creatinine Test Not Performed

HCPCS-G8731-PAIN-ASSESSMENT-NEGATIVE-NO-FOLLOW-UP

HCPCS G8731: Pain Assessment Documented Negative, No Follow-Up Required

HCPCS-G0476-HPV-HIGH-RISK-NUCLEIC-ACID-DETECTION-CERVICAL-SCREENING

HCPCS G0476: HPV High-Risk Nucleic Acid Detection for Cervical Screening

HCPCS-G9368-HIGH-RISK-MEDICATION-ORDERS-NOT-ORDERED

HCPCS G9368: High-Risk Medication Orders Not Ordered

HCPCS-G9508-NO-STATIN-MEDICATION-DOCUMENTATION

HCPCS G9508: Documentation of Not Being on a Statin Medication

HCPCS-G9886-BEHAVIORAL-COUNSELING-DIABETES-PREVENTION-GROUP-60-MIN

HCPCS G9886: Behavioral Counseling for Diabetes Prevention, Group 60 Minutes

HCPCS-G2251-VIRTUAL-CHECK-IN-BRIEF-TELEHEALTH-COMMUNICATION

HCPCS G2251: Brief Virtual Check-In for Established Patients

HCPCS-G0058-LOWER-EXTREMITY-JOINT-REPAIR-CARE-IMPROVEMENT

HCPCS G0058: Improving Care for Lower Extremity Joint Repair, MIPS VA Pathway

HCPCS-G8764-CARDIOVASCULAR-PREVENTION-MEASURES-COMPLETE

HCPCS G8764: Completion of Cardiovascular Prevention Measures

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`208000000X`	Pediatrics	Primary clinicians managing pediatric asthma and documenting controller use.
`207Q00000X`	Family Medicine	Primary care providers managing asthma in children and adults, documenting medication dispensing.
`364A00000X`	Pulmonary Disease	Specialists who manage moderate-to-severe asthma and review controller therapy use.
`363L00000X`	Allergy & Immunology	Specialists evaluating allergic contributors and controller medication needs.
`367500000X`	Nurse Practitioner	Advanced practice clinicians who perform follow-up, medication reconciliation, and quality documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J45.20`	Mild intermittent asthma, uncomplicated	Represents patients with asthma who may not require daily controller therapy; explains absence of controller fills.
`J45.30`	Mild persistent asthma, uncomplicated	Indicates asthma that commonly warrants controller therapy; absence of fills may indicate care gap captured by `G9808`.
`J45.40`	Moderate persistent asthma, uncomplicated	Higher-risk patients for whom lack of controller medication dispensing during the year is clinically significant for quality reporting.
`J45.50`	Severe persistent asthma, uncomplicated	Critical to identify when no controller fills occur; signals major care gap and potential for exacerbations.
`R06.2`	Wheeze	Symptom code often documented in encounters assessing asthma control and medication needs when `G9808` is reported.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Commonly used for routine follow-up visits where medication reconciliation determines no controller fills (`G9808`) and asthma management is reviewed.
`99395`	Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient	Used for annual preventive visits where quality measures are assessed and `G9808` may be reported if no controller medications were dispensed during the measurement year.
`99406`	Smoking and tobacco-use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	May be provided during an asthma visit where counseling is documented alongside assessment of controller medication use.
`94640`	Pressurized or non-pressurized inhalation treatment for acute airway obstruction; nebulizer therapy	Performed during acute visits if the patient has exacerbations; documentation may note absence of controller fills when `G9808` applies.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used when care management teams track medication fills and outreach identifies patients meeting `G9808` criteria as part of population health programs.

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